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Lecture 8

ANTC68- Lecture 8, march 7 .doc

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Bianca Dahl

March 7- 2013 HIV & AIDS- Lecture 8 • Human Immunodeficiency Virus • HIV-1 (95% of global cases, more virulent) & HIV-2 (mainly in West Africa) • A retrovirus (RNA virus that replicates inside a host cell) • Like influenza, high rate of mutation: makes vaccines difficult to produce Stages of Infection: 1. Acute Phase: brief period of influenza-like illness, fever, enlarged lymph nodes. Lasts a few weeks. *most transmission 2. Clinical Latency: prolonged period without symptoms (3-20 years) 3. AIDS: depleted immune function, opportunistic infection (many years; depends on treatment) AIDS • Acquired Immune Deficiency Syndrome • Can be diagnosed clinically: CD4+ T (an immune) cell count below 200 • Can be diagnosed based on co-infection • Most common: pneumonia, viral cancers (cervical, Kaposi’s sarcoma), respiratory tract infections, TB • Other symptoms: wasting, diarrhea, fever, sweats Transmission: 1. Sexual Intercourse (vaginal/anal) • Heterosexual transmission more common worldwide • Homosexual transmission more common in USA • Genital ulcers (syphilis, gonorrhea) increase chance of transmission. SYNDEMIC 2. Needle Sharing/Contaminated Blood • drugs • blood transfusions 3. Vertical (mother-child) • pregnancy • Birth • breastfeeding  Overall, heterosexual transmission  Ex. of a syndemic: AIDS easier to pass on if you have other STDs (gonorrea and syphilis)  In-utero , during pregnancy or birth process (mixing of blood between blood and baby causes baby to catch it -> to avoid this, have a C-section, and breastfeeding, so bottle feed their kids, but can’t always afford it).  We blame gay men Origin of Aids • First brought to global consciousness in 1981 • IV drug users and gay men showed up in American drug clinics in San Francisco and New York with previously rare infections (rare forms of pneumonia, skin cancer) normally found in immunocompromised • At first thought only to affect gay men. Originally called GRID: Gay-Related Immune Deficiency • Name changed to AIDS in 1982 • Original stigma still remains, the “Other” (gay men, drug users, Haitians) • Seems to have originated in West Africa • 1910? 1930? Genetic dating methods • Oldest known blood sample (1 case) from 1959 in Zaire • Closely related to SIV: Simian Immunodeficiency Virus • Rumours: sex with chimps • More likely: bushmeat? Contact with blood? • Spread to Haiti in 1960s, then to USA in 1970’s • Sexual tourism, migration  Other: anybody that is not us -> so disease was brought over from gay men, drug users, and Haitians  Bushmeant: eating wild animals  First known sample with HIV in their blood was 50 years ago!  Started in Africa, then Spread to Haiti, then US Stigma of “The Other” AIDS blamed variously on: • Homosexual men • Drug users • Haitians • Africans • Prostitutes • Moral connotation to blame, leads to discrimination • Paul Farmer calls this “The Geography of Blame” where Haiti is blamed for bringing AIDS into the USA while ignoring role that the West played in colonization and sexual tourism. • Those who are margilized are the most blamed. Spread of AIDS in Africa • AIDS in Africa not discussed until it was recognized in the USA • Why was it undetected? • Lower rates of transmission among heterosexuals? • Hidden by other diseases? • Other issues: war, famine, genocide • Denial of problem (tourism) • By 1959 • It was around for 20 years before we knew about it in the world • How did it exist for so long without people knowing about it? • It’s harder to transmit from heterosexuals • In Africa, there are so many other sickness • When it started in the 80s, when US was discovering AIDS, Africa said it’s not here, otherwise they would have stigma and lose tourism • Exploitation of Africa by the West: colonialism, slave trade, dictatorships, guns, forced labour, mining (ex. gold, diamonds) , rape as a weapon of war • Disruption of family life: • Men and women displaced • Men forced to move long distances to work in plantations (coffee, rubber, cocoa) • Temporary housing, psychological disturbances • Prostitution Force labour= disrupted family life in Africa AIDS Pandemic • Since the start of the pandemic, about 30 million people have died (WHO 2012) • AIDS hasn’t killed as many people as other diseases yet Global AIDS Prevalence 2011  5 countries in the world that has the highest prevalence  Switzerland, Botswana, Lesotho, South Africa, Zimbabwe  Subsaharan Africa:  life expectancy has dropped overall in these places  Drop in Life Expectancy  Life expectancy is getting higher in general, but in Botswana, life expectancy has dropped! ..due to AIDS Treatment • Most effective treatment is HAART: Highly Active AntiRetroviral Treatment • In 1996 a course of therapy cost US$10,000-$15,000 per person per year • 2000-01: generics introduced. Made treatment cheaper (as low as $300 per person per year), but issues of access • Acquired INCOME Deficiency Syndrome?  Know what HAART stands for !  Only happening in poor people Benefits: • Decrease severity of early symptoms • Slower rate of disease progression • Reduce rate of virus multiplying in body • Preserve immune system function • Lower risk of drug resistance with complete viral suppression • Reduce risk of HIV spreading (but doesn’t eliminate completely) • Extend life Risks: • High cost • Side effects, toxicity • Drug resistance of antiretroviral medications • Need for continuing therapy indefinitely > A lot of side effects Activism • UNAIDS has definite plans for prevention and treatment of AIDS Poverty and Compliance • Researchers have discussed issues of “non-compliance” with AIDS therapies • Among poor, drug users • They argue that treatment should not be “wasted”: it should be
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